Best of The Neuroethics Blog: Is football safe for brains?

Throughout the year, The Neuroethics Blog will be highlighting the most impactful, exciting, and popular posts from our nearly ten-year history. 

Today's post is an update by Dr. L. Syd M Johnson on her piece entitled Is football safe for brains?, which was originally published on October 27, 2015 and is republished below.

Image courtesy of Pexels.
Over the last several years, scientific research has continued to uncover evidence that football is unsafe for brains. Football is not the only sport implicated in concussions and the neurodegenerative brain disease Chronic Traumatic Encephalopathy. Hockey, soccer, and martial arts like boxing and MMA (mixed martial arts) are among the sports where head trauma, including subconcussive trauma, are both common and frequent for athletes. While a great deal of attention continues to be focused on professional athletes, a notable and important development in recent years has been increased awareness of the risks of these sports for adolescent athletes. There is growing evidence that participation in youth sports—even among athletes who do not go on to play college or professional sports—can lead to lasting changes in the brain, including earlier onset of cognitive, behavioral, and mood symptoms in later life. Some youth sports organizations have responded to concerns about brain injuries by increasing the age at which athletes are exposed to modes of play most likely to lead to brain trauma, such as body checking in hockey, and heading the ball in soccer. While these are positive changes that will prevent many injuries in youth athletes, they merely scratch the surface of the problem. 

As a university professor, I’ve seen too many students struggle to stay afloat academically after suffering repeated concussions. Some of them also worry about the loss of athletic scholarships should they become unable to play. The next front in the battle over sport-related neurotrauma will be, and should be, college sports, where young athletes play at a near professional level, and suffer the same injuries as their well-paid professional counterparts. They can also experience financially coercive incentives to ignore both the short and long term brain health effects. College sports are big business, wildly popular, and fans love their teams, but knowingly exposing adolescents and young adults to the risk of brain injuries—injuries that are all but unavoidable in some contact sports—is unjust, and ought to gnaw at our societal conscience.

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Is football safe for brains?

In recent years, there has been much public concern about the impact of football and other neurotraumatic sports on the brains of athletes. The neuroethics community has been somewhat slow in picking up sport-related concussion and Chronic Traumatic Encephalopathy (CTE) as topics of neuroethical concern. Public and media concern have been fueled by reports stating that the brains of deceased athletes show evidence of the distinctive tauopathy of CTE, attributed by researchers like Bennet Omalu (who described the first case in a retired football player in 2005) and Ann C. McKee (Boston University) to brain trauma sustained while playing sports. To date, there have been approximately 150 documented cases of CTE, and an exceptionally high number of the brains examined by Omalu, McKee, and colleagues have been positive for the characteristic tau depositions.

Of course, there is selection bias in neuropathological case studies, since few retired athletes donate their brains to research after death. Neuroscientist Alvaro Pascual-Leone of the FPHS was openly dismissive of the existing CTE research during his brief discussion of it, criticizing the work as woefully underpowered. The existing science is worth little, Pascal-Leone told the audience, implying that the current alarm about the neurological effects of football-related brain trauma is premature, and probably overblown.

The speakers commented that there are some 15,000 retired, living NFL players—a small, elite group—and the FPHS is attempting to recruit 10,000 of them for its studies. Funded by the National Football League’s Players’ Union, the FPHS proposes to tackle whole lifespan player health through population studies to assess the scope of health problems experienced by retired players, pilot studies to develop interventions, and a law and ethics component that outlines ethical principles important to considerations of player health and is sensitive to the unique conflicts of interest in professional sports. Only some of the work being done by the FPHS addresses brain trauma and its effects on athlete health—that part of their work was, of course, of most interest to the neuroethicists assembled for the meeting, but it received scant attention from the panel. Judging by the questions from the audience, they mostly had brain trauma on their minds as well.

Moderator Nita Farahany and panel members Alvaro Pascual-Leone, I. Glenn Cohen,
and Damien Richardson (pictured from left to right).

Concussion and neurotrauma in professional football are the subjects of much neuroscientific activity, but the bigger problem, briefly alluded to by law professor I. Glenn Cohen, is not what happens to adult, professional athletes, but to the large number of junior and amateur players. While there are millions of high school football players in the United States, only several thousands of these players continue to play at the college level, and an even smaller fraction go on to play in the professional ranks. This fall, seven US high football players have already died, most of them due to head trauma-related injuries. The majority of reported concussions in the US occur in high school football players, while the impact of all that head trauma remains largely unknown and understudied. Damien Richardson, a former NFL player, and now a doctor and advisor to the FPHS, discussed his own long path to the pros while sitting on the panel, beginning with Pop Warner football when he was a kid, through high school and college ball. When asked if he thought pro football was safe, he demurred, but explained that knowing what he knows now, he would still play, but would play differently than he did.

Richardson emphasized the need for change in professional football, change that would trickle down to influence the next generation of players coming up through the ranks. That model of top-down change has been endorsed by the NFL as well, but there is already evidence of bottom-up change, with greater attention to and concern about safety leading to fewer kids playing football, and opting for other sports instead. For many young athletes and their parents, there’s no longer any question about the safety of football.

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Dr. Johnson is an Associate Professor of Philosophy & Bioethics in the Department of Humanities at Michigan Technological University. Her work in neuroethics focuses on disorders of consciousness and sport-related neurotrauma. She has published several articles on concussions in youth football and hockey, as well as on the ethics of return-to-play protocols in youth and professional football.



    Want to cite this post?

    Johnson, LSM (2019). Best of The Neuroethics Blog: Is football safe for brains? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2019/06/best-of-neuroethics-blog-is-football.html

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